Adding vitamin C to hydrocortisone lacks benefit in septic shock: a historical cohort study
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Adding vitamin C to hydrocortisone lacks benefit in septic shock: a historical cohort study L’ajout de la vitamine C a` l’hydrocortisone n’ajoute pas de bienfaits en cas de choc septique: une e´tude de cohorte historique Kimberley Chang, MD . Megan Harbin, PharmD . Constantin Shuster, MD . Donald E. G. Griesdale, MD, MPH . Denise Foster, RN . David Sweet, MD . Michael D. Wood, PhD . Vinay K. Dhingra, MD Received: 6 March 2020 / Revised: 20 May 2020 / Accepted: 11 September 2020 Ó Canadian Anesthesiologists’ Society 2020
Abstract Purpose Sepsis has high incidence and mortality rates, particularly in the intensive care unit (ICU). Corticosteroids may improve outcomes, and vitamin C may add benefit. We aimed to assess whether vitamin C and corticosteroids improved outcomes compared with corticosteroids alone. Methods This historical cohort study (11 December 2016 to 21 February 2018) was conducted in the ICU of a
K. Chang, MD Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada M. Harbin, PharmD Department of Pharmaceutical Sciences, Vancouver General Hospital, and Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada C. Shuster, MD D. Sweet, MD V. K. Dhingra, MD (&) Division of Critical Care Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada e-mail: [email protected] D. E. G. Griesdale, MD, MPH Centre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada D. Foster, RN Department of Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada M. D. Wood, PhD Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada
quaternary referral hospital. Patients with an ICU admission diagnosis of sepsis or septic shock who received vitamin C and hydrocortisone within 72 hr were compared with those who received only hydrocortisone. All patients received standard sepsis care including source control, antibiotics, and fluid resuscitation. Most patients received thiamine as standard ICU care. The primary outcome was hospital mortality. Secondary outcomes included ICU mortality, ventilator-free days, vasopressorfree days, dialysis use, and duration of ICU admission. Results One hundred and forty-four patients were included in the study. The mean (standard deviation [SD]) age was 64 (15) yr; 39% were female; and the mean (SD) Acute Physiology And Chronic Health Evaluation IV score was 89 (30). Eighty-eight patients did not receive vitamin C and 52 received vitamin C. There was no observed difference in hospital mortality between the non-vitamin C (36%) and vitamin C (39%) groups (adjusted odds ratio for hospital death, 0.52; 95% confidence interval, 0.20 to 1.34; P = 0.18). There were no statistically significant differences in any seconda
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